MEDICARE: MR. LARRY GLEN PARTIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19117	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225193204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY GLEN PARTIN LPC

Provider Business Mailing Address
First Line	:	5713 GUADALAJARA DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-6123
Country	:	US
Telephone Number	:	469-831-9261
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WESTWAY PL
Second Line	:	STE 320
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5245
Country	:	US
Telephone Number	:	816-516-9100
Fax Number	:	817-516-9102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	06/24/2015

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